Hospice care: Medicare makes it affordable, but read the fine print

The rising costs of health care cause some people to skip or delay seeking services they need. But with hospice care, by comparison, there are usually fewer financial concerns, mainly due to the Medicare Hospice Benefit, which can cover up to 100% of hospice services.

Still, not everything in a hospice patient's care may be covered, and there are different scenarios families should learn about when seeking care for a loved one, says Debbie Johnston, author of "The Hospice Handbook: Nurse Debbie's Compassionate Guide To Navigating End-Of-Life Care."

"Medicaid and managed care/private insurance can also play roles," she says. "Medicaid eligibility varies by state. And people who use private insurance need to talk to their provider about deductions and co-payments and what the private insurance plan's eligibility requirements are.

"For people who aren't eligible for Medicare and can't pay any other way for hospice, charities often step in to assist."

Hospice care is for people with a life expectancy of six months or less. It focuses on easing symptoms and mitigating suffering without curing the underlying disease of a terminally ill patient. Other areas of emphasis of hospice care are attending to a patient's emotional and spiritual needs and prioritizing their quality of life. Ms. Johnston offers the following points about paying for hospice care:

¦ Medicare. Most hospice patients have their costs covered by Medicare. A person qualifies for hospice care if they have Medicare Part A (hospital insurance) and meet these conditions:

¦ Their hospice doctor and regular doctor certify that they're terminally ill, with a life expectancy of six months or less.

¦ They accept comfort care (palliative care) instead of care to cure their illness.

¦ They sign a statement choosing hospice care instead of other Medicare covered treatments for their terminal illness and related conditions.

"One who qualifies for hospice care pays nothing for it, but the patient may have to cover some drug costs," Ms. Johnston says. "Also, after six months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you're still terminally ill."

¦ What may not be covered. These include treatment or prescription drugs intended to cure your terminal illness rather than treat the symptoms and focus on pain management, Ms. Johnston says. Many hospice patients receive care in their home, but Ms. Johnston points out Medicare doesn't cover room and board if you live in a nursing home or a hospice in-patient facility. Medicare will, however, cover your stay if the hospice team determines you need short-term in-patient or respite care services they arrange. There may be a co-payment for the respite stay.

"Most hospices come to you – to your own house or if you're living in a nursing home – and their offices don't typically stay open 24/7," Ms. Johnston says. "They close daily like most other businesses. They are known as intermittent hospice care facilities; the caregivers might visit the home several times a week or even daily.

"When you're researching hospice care agencies that come to you, it's a good idea to ask what services they offer after regular business hours. They're required to have a nurse on call, and they might also have a chaplain and social worker available."

¦ Special situations. Ms. Johnston says Medicare also recognizes when continuous home care may be needed. "If a patient has an acute need for nursing care around the clock — not to prolong life through medical treatments but to provide palliative support at home, like monitoring oxygen or stemming seizures — then sometimes Medicare benefits cover this option," she says. "However, not many hospices provide continuous care because the practice invites a lot of federal scrutiny. The government doesn't want patients to receive unnecessary care, so they tend to inspect hospices that frequently offer this option to their clients."

¦ Supplement Medicare with private pay home care. Another way to receive 24-hour daily care and avoid government red tape, Ms. Johnston says, is to supplement Medicare benefits with private-pay home care. "Some hospices actually help the patient and families with this enrollment and have a list of reputable providers with whom they coordinate on behalf of the family," she says. "This 24-hour private pay supplemental care can take place at the patient's home or in a residential care facility."

"One plus a lot of people overlook about hospice is how it can enhance a patient's quality of life near the end of their life," she says. "And it can be paid for relatively easily compared to other areas of health care."

About Debbie Johnston

Debbie Johnston is the author of "The Hospice Handbook: Nurse Debbie's Compassionate Guide To Navigating End-Of-Life Care." A successful entrepreneur and health care expert, she founded Care Advantage Inc., which became a leading company for personal and companion home health care and was sold to Bell Health in 2017. With the foundation of her nonprofit organization, Connecting Hearts, Ms. Johnston was appointed Virginia's Adoption Champion by then-Gov. Terry McAuliffe. Her newest business, Serenity First Hospice, is inspired by her personal journey with her father, Pappy. She was featured on ABC television's "Secret Millionaire" and has received numerous local, state and regional awards for her efforts as a humanitarian, philanthropist, entrepreneur and business leader. ¦